Diagnostic stability of psychiatric disorders in clinical practice

Abstract

Background: Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. Aims: To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings. Method: Atotal of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992-2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000-2004 (n=546); psychiatric emergency room, 2000-2004 (n=1408); and out-patient psychiatric facilities, 1992-2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings. Results: The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses. Conclusions: The findings are an indictment of our current psychiatric diagnostic practice.